December 18, 2008

The order of disorder.

The psychiatrists are at it again, defining mental "disorders."
“This is not cardiology or nephrology, where the basic diseases are well known,” said Edward Shorter, a leading historian of psychiatry whose latest book, “Before Prozac,” is critical of the manual. “In psychiatry no one knows the causes of anything, so classification can be driven by all sorts of factors” — political, social and financial.

“What you have in the end,” Mr. Shorter said, “is this process of sorting the deck of symptoms into syndromes, and the outcome all depends on how the cards fall.”...

Experts say that some of the most crucial debates are likely to include gender identity, diagnoses of illness involving children, and addictions like shopping and eating.
IN THE COMMENTS: Henry says:
The article reads like the jury of the 1864 French Salon deciding to let the landscape painters back in. The standard is grand historical disorders (megalomania is always good), but that is hardly fair to the duller lunatics. They too deserve a viewing.

So you let in a few en plein aire disorders and the next thing you know the academy is overrun with fauves.

37 comments:

The Drill SGT said...

Just another attempt by shrinks to increase business by "medicalizing" politically or culturally uncorrect behaviors.

rhhardin said...

Goffman covers the sociology of psychiatry in Asylums.

Some excerpts I took out.

peter hoh said...

I want a monthly disability check for my internet addiction disorder.

Hoosier Daddy said...

“In psychiatry no one knows the causes of anything, so classification can be driven by all sorts of factors” — political, social and financial.

That's funny. Substitute 'climate change' for 'psychiatry' and that sentence works just as well.

ricpic said...

Transgender confusion in Scotland is out of control.

Mark O said...

If you wish to understand psychiatry and treatment, the best resource is right there in Madison: Dr. James P. Gustafson. I particularly recommend "Self-Delight in a Harsh World."

Some of this other stuff seems like witchcraft.

Meade said...

Years ago I was treated for RLAD (Real Life Adjustment Disorder). Doc Cochran gave me a slap upside the head, charged me a quarter, and I've been fine ever since. One slap is all it took.

MadisonMan said...

In psychiatry no one knows the causes of anything

I think this is a vast oversimplification. For example, causes of some depression are pretty well known -- if they weren't, how could the success of anti-depressants for some people be explained?

AllenS said...

I shall quote from the great psychiagrist of all time, Hank Williams, Jr.:

"An old boy jumped up and closed his mouth
And used his head for a mop and his butt for a broom.
It was an Attitude Adjustment, I guess it was his first time.
An attitude adjustment, now he understands just fine.
He got bent out of shape, then he opened his mouth
And just one appointment straightened him right out
It was an attitude adjustment--It'll work every time."

The Drill SGT said...

For example, causes of some depression are pretty well known -- if they weren't, how could the success of anti-depressants for some people be explained?

LOL, substitute "Coke, Heroin, Pot or Alcohol" for "anti-depressants" in the above statement

AllenS said...

psychiatrist

MadisonMan said...

Well, I substituted the words in. Changed the meaning of the sentence.

mcg said...

Grande Conservative Blogress Diva challenger Neo-Neocon has something interesting to say about therapists and liberalism that is somewhat related to this.

Titusisveryrelaxed said...

Is discussing your morning loaf with strangers on a blog a mental disorder?

mcg said...

yes.

Big Mike said...

How about reading blogs written by female law professors as a form of mental disorder? Did they think to include that one?

Henry said...

The article reads like the jury of the 1864 French Salon deciding to let the landscape painters back in. The standard is grand historical disorders (megalomania is always good), but that is hardly fair to the duller lunatics. They too deserve a viewing.

So you let in a few en plein aire disorders and the next thing you know the academy is overrun with fauves.

Georgfelis said...

You forgot the most recent diagnosis of a mental disorder: Attempting to auction a Senate seat.

Hoosier Daddy said...

Is discussing your morning loaf with strangers on a blog a mental disorder?

Now we're strangers? Sheesh Titus if that's how it is.

You're dead to me. Dead.

Tibore said...

"In psychiatry no one knows the causes of anything

I think this is a vast oversimplification. For example, causes of some depression are pretty well known -- if they weren't, how could the success of anti-depressants for some people be explained?"


I'd agree with you on that - it is an overblown way of saying it - but, I think it's better to understand psychiatry in this way: There's no real central dogma that the field can wrap itself around. In chemistry, the idea that electron affinity leads to bonds between atoms, and various combinations of these atoms being bonded together leads to predictable but unique macroscopic characteristics has been a central one for a long time, and provides the framework from which to analyze work in those fields. In biology (well, at least in molecular biology) states that DNA and RNA provide the storage for information that, when put through cellular systems, produce proteins, which lead to biological structures and processes. In physics, as best as I understand things, "central" dogmas are a bit mixed: You have the classical physics fields, and you have the quantum ones (relativistic physics falls into classical), and either of those provide the keystone that the rest of those subfields rest on. This goes on and on for various sciences.

What's the central dogma of the psychological/psychiatric fields? If it exists, I'm genuinely unaware of it; a friend working on an advanced degree in cognitive psychology and I have had this exact discussion, and he basically agrees with me in thrust, if not in details. Psychology and psychiatry are both in the same state that, say, biology was when it was basically taxidermy. Before the development of the knowledge of DNA, so much of biology consisted of simple classification and observation, and theories built around "external" observations did the best they could to describe what was happening - and some fine knowledge was developed anyway, despite these limitations - but ultimately could not provide the same level of insight that became available when the central dogma of DNA+RNA->proteins->structures and processes became understood. Chemistry was stuck in the same rut way back when it was called "alchemy". Physics oddly enough reached a very mature state way back in history - Eratosthenes figured out the diameter of the earth back in 250 BC (if it tells you how long ago this was, Eratosthenes was the chief librarian of the famous Great Library of Alexandria) - but it took Einstein in just this century to really get out of the Newtonian cage it had been previously confined in and onto it's currently understood fundamentals.

Well, Borh did the same in quantum physics too, but I'm starting to complicate the story. :D

Anyway, my point is that whatever the "central dogma" of the psychological/psychiatric sciences is, it's nowhere near as central, well developed, and "bedrocked" as it is for the older, more developed hard sciences. This isn't meant as a criticism of those fields, BTW, it's merely acceptance of the youth and level of knowledge of the fields. They're still valid sciences, they're just relatively young, and missing some central structure. It's to researchers credit that they're able to develop what they've currently developed in the absence of such knowledge; in a way, those field are actually frontiers still, with so much left to be discovered. But the flipside of that coin is that the level of understanding simply cannot be inclusive enough to be reliable 100% of the time when applied practically. The fact that many psychological disorders are still at the level of external descriptions is proof of this; when neurochemical and structural reasons for, say, ADD, or autism get developed, the "psy" fields will move their descriptions from the external to the truly descriptive, just like "consumption" eventually became known as "tuberculosis", then the field will really mature and become practical. Until then, the quote above may overstate things, but it's essentially correct when you think of it as not knowing the basic foundation of any given psychological issue being described.

former law student said...

How about naming your first-born Adolph Hitler, and complaining when the bakery won't put his full name on the cake?

Link to birth certificate photo, for doubters as well as birth certificate conspiracy theorists:

http://photos.lehighvalleylive.com/express-times/2008/12/adolf_hitler_cake_adolf_cake_1_1.html

Tibore said...

Ok, some corrections to my previous post:

"Electron affinity" - to the nucleus of an atom. Not to each other. I badly stated that point.

"... when neurochemical and structural reasons for, say, ADD, or autism get developed" - presuming they have neurochemical or structural reasons to begin with. We just don't know enough about either state to make that judgement. I shouldn't have put it that way.

William said...

In a psychology class I once had, the teacher was asked what percentage of the population was healthy and well adjusted. The teacher replied that the figure was about 16%. To me that seemed like a ball park figure--perhaps even a little high. At any rate, if we use normalcy as the gauge, aren't most sane, centered individuals exhibiting abnormal behavior......That's a facile paradox, but truly sanity and normalcy have only a chance correlation.

tim maguire said...

From Speed:

Keanu Reeves: You're crazy!

Dennis Hopper: No, poor people are crazy. I'm eccentric!

TMink said...

Well, there are two camps in Psychology and iatry. Those of us who are paying attention to the new brain research, and those of us who are worried about theory. I do not understand the people who are ignoring the new brain research at all.

With a Spect scan, you can see a person's adhd. And yet many people, many psychiatrists, are quite negative toward brain scans.

There is much, much more to learn, but I do not understand why that other camp is so opposed to some facts.

Trey

knox said...

What about the people who are Crazy for Swayze?

chickenlittle said...

"Maximum disorder was our equilibrium"

T.E. Lawrence, Seven Pillars of Wisdom

Quayle said...

Psychiatry divorced from underlying physical influence is a study of the interplay of whim, moods, penchants, fear, ambition, and free will, etc. Not much to build a scientific framework on.

Psychiatry, therefore, must seek to understand how the physical layer impacts or affects the non-physical manifestation of our being.

But nobody knows how the two (non-physical and physical) interact to create what we are each day.

Does the physical side create the mood? Or does the mood alter the physical side? Or both?

We clearly know that free will decisions can alter the physical development of a person. I refer to studies that show that the brains of orphans that were picked up and held develop differently than the brains orphans that were never held and left in their cribs.

There are also studies that show people that read a lot have different brain formations than people that don’t

Both of these physical developments were the result of someone’s free will decisions – so we know that decisions we make can and does alter our physical body in ways more subtle than obesity or heroin addition.

So the unanswerable question for psychiatrists can be analogized by: ‘are people depressed because their brains have some lower amount of a certain chemical, or does the brain have a lower amount of the chemical because the person chose to do or think in a certain way and their brain physical altered, adapted, or conformed?’

And this same issue exists for gays. When people talk about ‘being gay’, the first question is where in their person this ‘gayness’ is.

But the second (and ignored) question is, even if the ‘gayness’ can be isolated and shown to be physical, whether or not this ‘gayness” was caused or created by their or someone else’s prior decisions.

siyeh pass said...

LOL, substitute "Coke, Heroin, Pot or Alcohol" for "anti-depressants" in the above statement

Yeah, not so much (as stated by another commenter). Alcohol is actually a pretty effective depressant.

dannyboy said...

Alcohol is actually a pretty effective depressant.

I only get depressed if there isn't enough.

ricpic said...

Ah c'mon guys, Hoosier, Titus, don't be like that, makeup...that's it, embrace...uh-oh, there goes Titus' hog!

Methadras said...

dannyboy said...

Alcohol is actually a pretty effective depressant.

I only get depressed if there isn't enough.


In me. Corrected for truth.

jdeeripper said...

peter hoh said...I want a monthly disability check for my internet addiction disorder.

Specific to the Althouse blog: VSS - Vortex Susceptibility Syndrome

"There is no psychology; there is only biography and autobiography.

Narcissist: psychoanalytic term for the person who loves himself more than his analyst; considered to be the manifestation of a dire mental disease whose successful treatment depends on the patient learning to love the analyst more and himself less.

People often say that this or that person has not yet found himself. But the self is not something one finds, it is something one creates.

Formerly, when religion was strong and science weak, men mistook magic for medicine; now, when science is strong and religion weak, men mistake medicine for magic.

-- Thomas S. Szasz quotes

TMink said...

Szasz is quite the guy for quotes, but ANYONE who spent a little time in a low functioning mental hospital knows that mental illness is no myth.

Now the tripe that the moonbats at the APA come up with is first class bovine feces, but schizophrenia is no construct and no walk in the park.

Trey

John Hillery said...

Thier organization logo should be a flock of quacking ducks.

Titusisveryrelaxed said...

Now I am questioning mentioning my morning loaves.

But I like talking about my morning loaves.

I don't just talk to them about strangers I share them with my friends. I even leave voicemail messages to my friends of the loaves taking place with added grunts before each push. I have also sent pictures of them to my friends. One of my friends printed one of them out and framed it and gave it to me for my birthday. It was very special and quite emotional.

fishwrangler said...

"TMink said... ANYONE who spent a little time in a low functioning mental hospital knows that mental illness is no myth.Now the tripe that the moonbats at the APA come up with is first class bovine feces, but schizophrenia is no construct and no walk in the park."

TMink is too right. I worked for years in locked psych units as a nurse. And I have seen schizophrenics who's auditory and visual hallucinations keep them from partaking in the reality most of us share.
But much of this APA definition foolishness is done in an attempt to con money from insurance companies.
The successes of some medications does not necessarily prove that we know what caused the disease treated. Often it is just trial and error and good luck.